We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
from Section 4 - Pelvis and perineum
Published online by Cambridge University Press: 05 July 2015
Checklist
WIPER
• Patient standing. Trousers removed. Exposure from nipple to knee. Chaperone as required.
Physiological parameters
Inspection
• Scrotal asymmetry: pathology within hemiscrotum:
• absent testicle: failure of scrotal development or testicular descent, or orchidectomy
• scrotal mass
• Skin:
• oedema, cellulitis, Fournier's gangrene
• scars from previous scrotal surgery or orchidopexy
• Groin: scars (hernia repair) and masses (undescended testis)
Palpation
Patient standing:
Ask: ‘Do you have any pain?’
• Anatomy: define (a) superficial inguinal ring, (b) spermatic cord and vas deferens, (c) testicle, (d) epididymis. Compare left and right sides.
• Scrotal skin lumps: sebaceous cysts, abscesses and furuncles.
• Testicle: presence, contour, masses, size. If absent testicle, palpate groin and see if able to manipulate testicle into scrotum.
• Epididymis (posterior aspect of testis): tender or swollen.
• If scrotal mass felt:
• Can you get above it?
• Can you define testis and epididymis separately?
• Does the mass transilluminate (hydrocoele)?
• Is there a cough impulse (hernia/varicocoele)?
Patient supine:
• Re-examine the scrotum. Assess if any palpable abnormality becomes less prominent, as in the case of a varicocoele or hernia. Always ensure the scrotum is lifted up to inspect the posterior aspect of the scrotum and perineum.
To complete the examination…
• Examine the abdomen, especially if the testicle feels abnormal.
• Examine groin, penis and perineum: identify hernias, undescended or ectopic testes.
Examination notes
What are the essential history points for a scrotal mass?
History as for any mass (see Chapter 39, Examination of skin lesions and lumps). Specific points to elucidate:
• Previous scrotal operations
• Risk factors for testicular malignancy (undescended testis, family history, infertility, small testis)
What do you look for on inspection of the scrotum?
• Assess scrotal symmetry and development. Scrotal asymmetry together with the history may indicate the underlying pathology: e.g. a patient with a recent history of an inguinal hernia repair who has a smaller testicle on the same side would suggest testicular atrophy following hernia repair (ischaemic orchitis).
To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
